Fast Five Quiz: Skin Cancer

William James, MD


January 04, 2019

A 4-mm margin of healthy tissue is recommended for lower-risk lesions. In this category are well-differentiated tumors smaller than 2 cm in diameter that do not occur on the scalp, ears, eyelids, lips, or nose and do not involve subcutaneous fat. Therefore, simple excision is most valuable in the treatment of small primary SCCs on the trunk, extremities, or neck, where tissue sparing is less essential.

Although advances in the care of metastatic melanoma with immunotherapy have been realized, melanoma is known to be a relatively chemoresistant tumor. As such, chemotherapy has yielded poor results and no regimen has been found to definitively impact survival.

In addition to being an off-label indication, another drawback to topical tazarotene for the treatment of BCC is that it requires long-term therapy, for 5-8 months. The only reported adverse effect is dry/irritated skin, which is relieved after discontinuation of tazarotene. Topical 5-fluorouracil 5% cream may be used to treat small, superficial BCCs in low-risk areas. Interferon alfa-2b has also shown some success in treating small (< 1 cm), nodular, and superficial BCCs. Imiquimod 5% cream is approved by the US Food and Drug Administration for the treatment of nonfacial superficial BCC.

The aforementioned 2015 European guidelines on the diagnosis and management of Merkel cell carcinoma included the following regarding treatment:

  • The primary tumor should be excised with 1-2 cm margins

  • In patients with regional lymph node involvement, radical lymphadenectomy is recommended

  • Adjuvant radiation therapy may be considered in patients with multiple affected lymph nodes of extracapsular extension

  • In unresectable metastatic Merkel cell carcinoma, monochemotherapy or polychemotherapy achieve high remission rates; however, responses are usually short-lived

  • Treatment within clinical trials is regarded as a standard of care in disseminated Merkel cell carcinoma

For more on the treatment of SCC, read here.


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